Patient views and lived experiences: understanding and improving the evidence base for secure inpatient services

Jackson, Amy Louise (2023). Patient views and lived experiences: understanding and improving the evidence base for secure inpatient services. University of Birmingham. Foren.Psy.D.

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Abstract

The evidence-base for secure inpatient services has historically assigned little prominence to the patient voice. Broadly speaking, this thesis seeks to establish whether the field has progressed in more recent years. Its specific aims are to take an in-depth look at the literature relating to the views and experiences of patients; and to establish the state of the literature within the framework of trauma-informed care (TiC). Insights and knowledge gained will be used to consider areas of the empirical base that may be lacking or would benefit from being enhanced. Chapter One sets the scene with an overview of secure inpatient services. It then highlights the limitations and failures of traditional medically focused research hierarchies, alongside the emergence of TiC. Chapter Two presents a meta-synthesis of the lived experiences of secure inpatient services. Scoping searches reveal increased research attention is being paid to the secure inpatient voice. Yet, limited research into the aspects of care that may be of most significance to patients themselves. Addressing this gap, findings revealed that patients mostly discussed their experiences in the context of: relationships with staff on the ward; re-enactment of adverse early life experiences and subsequent survival strategies; and personal recovery. Findings are interpreted with reference to the wider literature, which generated patient-led recommendations for practice and future research. Chapter Three presents a systematic literature review to establish and improve understanding of what the literature base tells us about TiC within secure inpatient services. Initial scoping searches of the wider TiC literature across various domains demonstrate that it is a rapidly growing yet formative and highly complex field of academic study. With this in mind, the review addresses five specific aims: (i) to determine how TiC has been defined within the literature base; (ii) to identify the specific components of TiC that have been operationalised and/or implemented in practice; (iii) to identify any evaluations of TiC, including both the potential and/or actual impact of implementation; (iv) to identify future recommendations regarding TiC for both practice and research; and (v) to identify any additional and relevant key findings or discussion points that provide deeper insights into the discourse surrounding use of the term TiC. Results indicate the literature is growing, but is very much in its infancy. The complex picture presented is one that is both compatible and, to a larger degree, incompatible with a trauma-informed approach. This suggests TiC is an under-developed area and has perhaps been misrepresented by some in the academic field. After exploring the various systemic and interpersonal factors that pose a barrier to such a significant paradigm shift, recommendations are made to move the field forwards. Chapter Four examines the psychometric properties of The Working Alliance Inventory – Short Revised (WAI-SR) (Hatcher & Gillasby, 2006) as a tool to measure patient-staff relationships within secure inpatient services. Findings suggest that the WAI-SR, in its current form and as a stand-alone measure, is not appropriate for use within these settings. Alternative recommendations are made for services to measure, or at least pay closer attention to, the quality of relationships on the ward. Chapter Five draws together the findings of each of the three main chapters, summarising the areas of the empirical base that are lacking and would benefit from enhancement. Its strengths and limitations are acknowledged, before drawing overall conclusions.

Type of Work:

Thesis (Doctorates > Foren.Psy.D.)

Award Type:

Doctorates > Foren.Psy.D.

Supervisor(s):